Format

Send to

Choose Destination
BJOG. 2016 Mar;123(4):598-605. doi: 10.1111/1471-0528.13477. Epub 2015 Jun 26.

Invasive therapies for primary postpartum haemorrhage: a population-based study in France.

Author information

1
Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
2
Department of Obstetrics and Gynaecology, APHP, Trousseau Hospital, Université Pierre et Marie Curie, Paris, France.
3
Aurore Perinatal Network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.

Abstract

OBJECTIVE:

To describe the characteristics, management, and outcomes of women undergoing invasive therapies for primary postpartum haemorrhage (PPH).

DESIGN:

A population-based observational study.

SETTING:

All 106 maternity units of six French regions.

POPULATION:

A total of 146 781 women delivering between 2004 and 2006.

METHODS:

Prospective identification of women with PPH managed with invasive therapies, including uterine suture, pelvic vessel ligation, arterial embolisation, and hysterectomy.

MAIN OUTCOME MEASURES:

Rate of use and failure rate of invasive therapies, with 95% confidence intervals (95% CIs).

RESULTS:

An invasive therapy was used in 296 of 6660 women with PPH (4.4%, 95% CI 4.0-5.0), and in 0.2% of deliveries (95% CI 0.18-0.23). A hysterectomy was performed in 72/6660 women with PPH (1.1%, 95% CI 0.8-1.4%), and in 0.05% of deliveries (95% CI 0.04-0.06). A conservative invasive therapy was used in 262 women, including 183 (70%) who underwent arterial embolisation and 79 (30%) who had conservative surgery as the first-line therapy. Embolisation was more frequently used after vaginal than caesarean delivery, and when arterial embolisation was available on site. The failure rate of conservative invasive therapies was 41/262 (15.6%, 95% CI 11.5-20.6) overall, and was higher after surgical than after embolisation procedures, in particular for vaginal deliveries.

CONCLUSIONS:

Both maternal mortality as a result of obstetric haemorrhage and the rate of invasive therapies used for PPH are high in France. These findings suggest flaws in the initial management of PPH and/or the inadequate use of invasive procedures.

TWEETABLE ABSTRACT:

Maternal mortality as a result of haemorrhage and the rate of invasive therapies used for PPH are high in France.

KEYWORDS:

Embolisation; hysterectomy; maternal mortality; pelvic vessel ligation; postpartum haemorrhage; uterine compression sutures

PMID:
26113356
DOI:
10.1111/1471-0528.13477
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center